The nursing profession continues to argue whether a nurse who holds a BSN is desirable to the Associates-Degree-prepared nurse. This has been a topic of debate since 1965, when the American Nurses Association published an opinion paper advocating for the baccalaureate degree to be the minimal standard for entry-level nurses. While some say that the level of education isn’t relevant once you orient a nurse to a certain setting, others disagree and assert that the baccalaureate degree prepared nurses demonstrate higher levels of skill in communication, delegation, assessment, teaching and supervision.
Most agree, however, that each degree program provides a different level of preparation and competencies for the graduating nurse. The focus of ADN programs has been to prepare the nurse with considerable clinical experience and technical nursing skills needed to provide patient care at the bedside, while the BSN program concentrates on evidence-based practice, research, leadership skills and communication. An additional difference is the target client. Associate-degree graduates are prepared to meet the needs of the patient.
The baccalaureate graduate’s scope is widened to include the family and interdisciplinary groups.
According to a study done in 1988 by the Texas Higher Education Coordinating Board, nursing competencies across the spectrum of nursing education, “varied in complexity, depth, and breadth. ”(Poster, 2006) Entry-level competencies were evaluated on three categories: provider of care, coordinator of care, and member of a profession. There was virtually no difference noted in the provider of care category other than the use of an evidence-based analytical approach by the baccalaureate-prepared nurse, as opposed to a critical thinking approach to decision making by the associate-degree-prepared nurse.
In the category of coordinator of care, the major contrast was between how the advanced-degree-prepared the nurse to act as more of a facilitator of care between multiple factions of the healthcare team. As a member of a profession, the BSN nurse acted as a leader rather than in the participant role of the ADN nurse. Where the major differences occurred was in the “knowledge required for achievement of competency. ”(Poster, 2006) The diploma prepared nurse bases her plan of care on the nursing diagnosis.
The advanced-degree nurse’s basis for developing the plan of care uses “evidence-based and theoretical analysis of available data. ”(Poster, 2006) An example of this difference might be in the care of patient who has a chronic condition, such as congestive heart failure. This patient undoubtedly is seen multiple times in the course of a year for symptoms pertaining to his health condition. Nurse A, with the associate’s degree, does a good job of taking care of the patient. She sees to it that he gets all of his medications in a timely fashion, and that he completes all of his scheduled tests; that his basic needs are met.
Her plan of care would include all of the interventions to reflect such care. She would weigh him daily, make sure his meals followed the proper diet, and etc. Nurse B, with the BSN, also provides the afore-mentioned care. However, in addition, she may look at why this patient has frequently been admitted to her floor. She would perhaps investigate whether the same symptoms precipitated his decline and question the patient as to whether he is weighing himself daily, what types of food he is eating at home, and whether he has been taking his medications on a routine basis.
She might find that he doesn’t have a scale at home, does not have access to his medications all of the time, or is simply non-compliant. Her plan of care may include a social worker and case management are more involved in his discharge planning to insure that the patient has the equipment and resources required to manage is illness at home. Nurse B might also collaborate with the patient to develop a plan he can agree to follow and provide a list of community resources that are available. Both Nurse A and Nurse B have seen to it that the patient got what he needed during his hospital visit. The healthcare industry is changing rapidly.
The life expectancy of the average patient has extended due to the increase in technological advances and life-saving measures and requires that professional nurses have the ability to mange these complex patients. The baccalaureate-degree program provides an opportunity to build on the communication, problem-solving and decision-making skills taught in the ADN program to facilitate better patient care. Whether it be a an associate-degree-prepared nurse or one holding an advanced degree, one thing I am sure we can all agree upon is that better educated nurses will better serve the profession as a whole.
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